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Obstetrics and Gynecology > Renal And Urinary Tract > Flashcards

Renal And Urinary Tract Flashcards

1
Q

Significant changes

A

Kidneys become larger
Inc plasma flow and GFR 40-65%
R Dilatation of renal calyces and ureters - progesterone and mechanical obstruction
Vesicoureteral reflux - incompetence due to bladder flaccidity

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2
Q

UA

A

Occasional glucosuria

Unchanged in normal pregnancy

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3
Q

Abnormal proteinure

A

> 300mg/day

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4
Q

Albumin protein excretion

A

5-30 mg/day

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5
Q

+1 or greater blood on urine dipstick when screened before 20 weeks

Risk for developing preeclampsia

A

Idiopathic hematuria

2 fold

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6
Q

Serum creatinine threshold

A

> 0.9 mg/dl (75 umol/L)

If persistent, consider intrinsic disease

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7
Q

Done for recurrent UTI, hematuria, polyps, stones, tumors or cancer in urinary tract

A

Cystoscopy

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8
Q

Done for stone removal during pregnancy

A

Ureteroscopy

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9
Q

Renal biopsy

A

Postponed until postpartum 7% chance of complication

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10
Q

Most common bacterial infection during pregnancy

A

Asymptomatic bacteriuria

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11
Q

Asymptomatic bacteriuria risk is inc because

A

Mechanical and hormonal changes promoting urinary stasis and vesicoureteral reflux
Short urethra
Improper perineal hygiene

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12
Q

90% of non-obstructive pyelonephritis is caused by

A

E coli

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13
Q

Present in E coli that enhance bacterial adherence and inc their virulence

A

P fimbriae
S fimbriae
adhesins
surface proteins

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14
Q

Risk factors that predispose woman to UTI in puerperium

A

Dec bladder sensitivity to intravesical fluid tension
Dec bladder sensation to distention

Do IE before discharge!!

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15
Q

If patient cannot walk postpartum, it is due to

A

Hematoma

Urinary retention

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16
Q

Risk factors that increase likelihood of retention

A 
Primiparity
Perineal laceration
Oxytocin-induced or augmented labor
Operative vaginal delivery
Cathteterization during labor
Labor >10 hours
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17
Q

Asymptomatic bacteriuria Dx

A

Urine culture >100,000

Treat bec of high chance of developing symptomatic infection (20,00-50,000)
Dec incidence pyelonepritis

Screening for bacteruiria on first visit recommended

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18
Q

Asymptomatic bacteriuria Tx

A 
Single dose
Amoxicillin 3g
Ampicillin 2g 
Cephalosporin 2g
Nitrofurantoin 200mg
TMP-SMZ 320/1600

3 day course
Same as above
Ciprofloxacin 250
Levofloxacin 250

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19
Q

When dispensed during later course 30 days before delivery, has been linked to inc risk of neonatal jaundice but overall teratogenic potential is LOW

A

Nitrofurantoin

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20
Q

Cystitis and Urethritis Tx

A 
3 day course
Amoxicillin 500mg
Ampicillin 250mg
Cephalosporin 250mg
Ciprofloxacin 250mg
Levofloxacin 250mg 
Nitrofurantoin 50-100mg
TMP-SMZ 160/800mg
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21
Q

Lower urinary tract symptoms
Pyuria
Sterile urine culture

A

Urethritis from Chlamydia trachomatis

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22
Q

Chlamydia trachomatis Tx

A

Azithromycin

23
Q

Most common serious medical complication of pregnancy

Leading cause of septic shock
Fever, chills and flank pain
Leukocytes in clumps
Numerous bacteria

Most occur in 2nd trimester

Unilateral, right sided

A

Renal infection

Rf:
Nulliparity
Young age

24
Q

70-80% of infections

Most common organism

A

E coli

Kleb 3-5%
Enterobacter or proteus 3-5%
Gram + (Group B strep and staph)

25
Q

Should be monitored in pyelonephritis because 20% of women develop renal dysfunction

reduced to 5% if aggressive fluid management done early

A

Creatinine

26
Q

Pyelonephritis Tx

A

Admit
Urine and blood culture
Hemogram, serum crea and electrolytes
Cath (24 h urine collection)

UO >/= 50ml/hr with IV crystalloid

IV antibiotics - oral, and discharge if afebrile more than 24h

Repeat urine culture 1-2 weeks after

27
Q

Cornerstone of pyelonepritis tx

A

IV hydration

28
Q

Fever should be controlled in pyelo because of possible

A

Teratogenic effects

29
Q

Do renal UTZ if there is

A

persistence of fever >3 days

Rule out obstruction

Last option, MRI

30
Q

Identifies 90% of renal calculi

A

Plain Ab

Modified one-shot IVP
Stent to relieve obstruction and left in place until delivery

31
Q

Patchy interstitial scarring
Tubular atrophy
Loss of nephron mass

Chronic pyelonephritis because of vesicoureteral reflux

Long term complication: Hypertension

A

Reflux Nephropathy

32
Q

80% of stones
Polygenic familial idiopathic hypercalciuria

65-75% of stones in pregnancy

Low calcium diet promotes stone formation

A

Calcium salts
Calcium phosphate
Calcium hydroxyapatite

33
Q

Nephrolithiasis Tx

A

Hydration
Diet low in sodium and protein to prevent recurrence
Thiazide diuretics

34
Q

Indication for removal of stones

A

Obstruction (very painful)
Infection
Intractable pain
Heavy bleeding

35
Q

Nephrolithiasis removal in pregnant

A

Flexible basket via cystoscopy
Ureteroscopic removal
Ureteral stent
Percutaneous nephrostomy

36
Q

Contraindicated for removal of neprolithiasis in pregnant

A

Lithotripsy

Pain increases risk for contraction leading to preterm birth

37
Q 
Pain in 90% 
Gross hematuria
UTZ 
One shot pyelogram (to see stones in ureter)
CT scan only postpartum
A

Nephrolithiasis

38
Q

This drug should be stopped in renal transplant patients if they want to get pregnant because teratogenic

6 weeks prior to conception

A

Mycophenolate mofetil

39
Q

Incidence is high in all transplant patients

A

Preeclampsia

GDM

40
Q

Most frequent viral infection following renal transplant

A

Polyomavirus hominis 1

BK

41
Q

Autosomal dominant
Ciliopathy

Hypertension in 70%
Progression to renal failure

Involves liver, heart and brain

A

Polycystic kidney disease

42
Q 
HTN
Hematuria
Red cell cast
Pyuria
Proteinuria
A

Nephritic

43
Q

Most common nephritis syndrome

A

IgA Nephropathy Berger disease

44
Q 
Proteinuria
Hypoalbuminemia
Hypercholesterolemia
Edema
Hypertension

Renal biopsy if etiology to be determined

Vulvar edema
Chronic HTN
PreEclampsia

A

Nephrotic syndromes

45
Q

Pregnant undergoing dialysis

A

Multivitamin doses doubled
Calcium and iron salts provided
Chronic anemia with epo
Extra calcium to diasylate with less bicarbonate

46
Q

High morbidity
High mortality

Sudden impairment of kidney function with retention of nitrogenous waste and other waste products normally excreted by kidneys

Severe pre eclampsia and hemorrhage
HEELP
Septicemia
Acute fatty liver in pregnancy
Dehydration from hyperemesis gravidarum
Thrombotic microangiopathy
A

AKI

47
Q

Most common outcome following AKI

A

Preeclampsia 70%

48
Q

Important sign of acute impaired renal function

A

Oliguria

49
Q

Contraindicated in treatment of oliguria

A

Loop diuretics

50
Q

AKI is most often due to

A

Acute blood loss associated with preeclampsia

51
Q

Originate from an enlarging paraurethral gland abscess that ruptures into urethral lumen

A

Urethral diverticulum

52
Q

Urethral diverticulum Tx

A

Expectant during pregnancy

MRI if necessary

53
Q

Caused by McDonald
cerclage
prolonged obstructed labor

A

Vesicocervical fistula

Obstetrics and Gynecology (18 decks)

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